They meet every week at a small, government-funded health clinic in Kawempe, the poorest and most crowded suburb of the Ugandan capital. They vary in age, but nearly all are married or widowed. Most contracted HIV from a husband or long-term partner.
They are members of the Kawempe Positive Women’s Union (KPWU).
Beatrice Kanushu is the energetic chairperson of the union and her story is typical. Her husband was murdered in 1984 and her in-laws subsequently took away all her family’s property, leaving her with five children and no income.
She then took up with a man who promised to support her and pay her children’s school fees. He did so, for several years — but unknown to her, he was doing the same for several other women.
”I think if I had enough property or a job, I don’t think I would have gone to look for another man,” Kanushu says.
One day in 1988, her sister told her that the man looked ill. Kanushu’s sister, a nurse, suspected that he had HIV and advised Kanushu to stay away from him. Kanushu broke off the relationship, but it was too late.
”From that time on I abstained, but it was in vain because I was already infected,” she said.
Kanushu’s former partner died in 1989, but she did not get tested until 1998. Now 50, she is hoping to get access to the free, life-prolonging anti-retroviral drugs (ARVs) that are just now becoming available in Uganda.
The women of the KPWU are among the new faces of the HIV/Aids epidemic in Uganda. The recent Aids conference in Bangkok, Thailand, shed light on the growing feminisation of HIV.
According to the United Nations Joint Programme on HIV/Aids (UNAids), 57% of those infected in sub-Saharan Africa are women. And 75% of the young people infected are females aged 15 to 24.
Uganda’s Ministry of Health estimates the country’s current national HIV prevalence at 6,2%, a steep decline from the double-digit infection levels seen in the early 1990s. However, HIV prevalence rises to 10% for those who are widowed, divorced or separated, according to the Ministry of Health.
Data from the Aids Information Centre also shows that about 10% of females in the 15-to-24 age group in Uganda’s capital, Kampala, were testing positive in 2002 (compared with 2,3% for males in the same age group).
The increasing number of women being infected with HIV in Uganda is a result of women’s low status in marriage and society, explains Jacqueline Asiimwe Mwesige, coordinator of the Uganda Women’s Network.
”It’s the lack of control they have over their bodies and the kinds of protections that are out there for them to use to protect themselves against HIV/Aids,” she says.
Mwesige argues that traditions such as polygamy, bride price and widow inheritance play important roles in gender inequality. She says the practice of bride price contributes to the pervasive belief that a woman cannot refuse sexual intercourse with her husband.
”That exchange means that he’s exchanging my labour, the rights over my body, he owns my body, he owns my labour, and that’s the notion that you cannot say no to your husband.”
Although recent studies on Ugandan sexual behaviour show an increase in the age of first sexual intercourse and a decline in the number of sexual partners, many women say that men continue to have sex outside marriage and that poverty pushes young girls, widows and divorced women into risky relationships.
Activists like Mwesige say that Uganda’s much-imitated ABC (abstain, be faithful, use a condom when necessary) prevention strategy does not help married women.
”If a woman was having sex with herself it would be working,” Mwesige says, ”Because I think that society is already set up to enforce these kinds of rules for women. By and large, we’re the ones expected to abstain or be faithful. That’s the difficulty — that for so long morality has been skewed more on one gender’s side. So I will sit there and be faithful, but to what end and with what result?”
And condoms are still not necessarily an option, either. Joyce Kadowe of the Uganda Aids Commission says although condom use has risen in Uganda, many married couples still reject them, because condoms signify infidelity. She notes that men often work in the city, where they have a girlfriend, and leave their wives in the village to raise the children.
If the wife requests that he use a condom, Kadowe says, he will accuse her of being unfaithful. Kadowe adds that few couples go for HIV testing together because they are afraid of what it will reveal about their relationship.
Indeed, the nurses at the Kawempe Health Centre agree that most of the people who come for testing are women between the ages of 15 and 35. On the day this reporter visited, 15 people had been tested, six of whom were positive.
In its 2003 report Just Die Quietly: Domestic Violence and Women’s Vulnerability to HIV in Uganda, Human Rights Watch alleged that Ugandan women are becoming infected with HIV because the state fails to protect them from domestic violence.
”Violence, or the threat of violence, deprived women of bodily integrity by eliminating their ability to consent to sex, to negotiate safer sex and to determine the number and spacing of their own children,” the report charged.
”Women attended HIV/Aids clinics in secret and were afraid to discuss HIV/Aids with their husbands, even when they suspected that the men were HIV-positive and were the source of their own infection.”
There are few statistics on the prevalence of domestic violence in Uganda, but a study published in 2003 found that in the Rakai district of Central Uganda, 30% of women had experienced physical threats or physical abuse from their current partners, and that 70% of men and 90% of women viewed the beating of a wife or female partner as acceptable in some circumstances.
Kadowe says women and young girls in the conflict zones of Northern Uganda also account for many recent HIV infections.
The long-running insurrection by the Lord’s Resistance Army has forced much of the population of the north into overcrowded refugee camps, where violence is routine, and the rebels have also abducted thousands of women and girls as sex slaves.
”When it comes to HIV, many of them have been infected, and yet such women who are quite a faithful group, they can no longer protect themselves,” says Kadowe.
Even after years of HIV-prevention programmes, many married women in Uganda lack access to information about the disease. The majority of Uganda’s population is in rural areas and, according to Kadowe, the rural communities mainly comprise women, because men are working in the cities.
Many people in the villages lack radios, and because there is so little electricity, even those with radios use them parsimoniously because of the cost of batteries.
”So the educational programmes on the radio become a luxury,” Kadowe observes. ”And the newspapers also don’t go to the villages. So this information doesn’t reach the biggest population which is living in the rural communities.”
Activists remain optimistic that new legislation may help rectify the situation. The Domestic Relations Bill will criminalise marital rape, make bride price optional and equalise women’s position in the family by reforming a number of existing laws on marriage and divorce.
Though the Bill was introduced into Parliament with great fanfare in late 2003 and is supported by President Yoweri Museveni, it has so far languished in committees. Mwesige is concerned that it has fallen victim to the growing hubbub about whether Museveni will change the Constitution to run for a third presidential term.
News of the development of microbicides has also raised the hopes of many women. These could be produced as gels for a woman to use before sexual intercourse and would kill the HIV virus without necessarily preventing pregnancy. Most importantly, a woman could use them without her husband’s knowledge.
As women and girls wait for the gel, Aids campaigners say that Uganda needs to scale up its protection of women and girls.
”If not, more African women will die thinking that waiting for sex until marriage will protect them forever and evermore,” warns Ruben F Del Prado, UNAids country director for Uganda.
Del Prado asserts that Uganda has been resting on its laurels and that the country’s thinking and methodology on Aids prevention needs to change if further infections, especially in women, are to be thwarted.
”What we need now is something different. We need the next step. We need the introduction of the next generation of success for Uganda. Because if we keep looking back at what worked, and we don’t look at the changing environment, the things that worked then won’t work today,” Del Prado says.
”There are a lot more people infected today than were then, there are now ARVs that were not available then, there is a lot more money now. We need to put this money to work.” — IPS